Citation: Maione V, Tonon F, Soglia S, Venturuzzo A, Venturini M, Calzavara-Pinton P. Line-Field Confocal Optical Coherence Tomography of a Suspected Case of Galli-Galli Disease. Dermatol Pract Concept. 2024;14(1):e2024007. DOI: https://doi.org/10.5826/dpc.1401a7

BACKGROUND:Chronic leg ulcers affect approximately 1% to 2% of the European population, with an increasing prevalence. The treatment of chronic wounds is a socioeconomical problem worldwide.PURPOSE:The main purpose of the current investigation was to detect the etiology of leg ulcers treated in a dermatologic wound clinic from January 1, 2010, to December 31, 2019.METHODS:This retrospective observational study was performed at the Dermatologic Clinic of Spedali Civili in Brescia, Italy. The authors enrolled 465 patients with chronic leg ulcers.RESULTS:The 3 most represented causes of ulcers were vascular (238 patients, 51.2%), inflammatory (71 patients, 15.3%) and traumatic (43 patients, 9.3%). Altogether, a total of 13 different entities were identified as a cause of leg ulcer.CONCLUSION:Vascular genesis was the most common etiology of leg ulcers in this population, even though uncommon causes were also represented. These findings are in agreement with other studies reported in the literature.

and analyzed for the presence of heavy metals. All the metals tested for were below the EPA range for “maximum contaminant level (MCL)” for drinking water except copper, which was elevated by 8% of normal (MCL = 1, result = 1.08). Metals below the MCL included barium, cadmium, chromium, lead, silver, and zinc. Arsenic, selenium, and mercury were not detected in the water sample. Three years after the initial skin eruption, he remains asymptomatic. This patient represents a unique and rapid resolution of LP upon purification of his well water supply. The manifestations of LP are thought to entail any of the following causes: immune dysregulation, infectious, and environmental and genetic factors. Our patient’s condition, with a follicular pattern of LP, would have been expected to persist longer and been recalcitrant to standard therapy approaches given remission rates within 1–2 years. We initially postulated that there may have been contaminant trace elements or metals that contributed to this patient’s condition given the spontaneous resolution of symptoms after addition of a water softening system. It has previously been documented that copper-containing dental prosthetics can induce oral LP and that symptoms resolved with removal of the appliance. Our hypothesis is that the copper contaminant found in this patient’s water could have induced a generalized lichenoid dermatitis like those that have been described in the oral cavity secondary to metallic components from metal tooth restorations. The metals previously described in the oral cavity as inducers of allergic oral lichenoid contact lesions have been Ag, In, Au, Pd, Zn, Cu, Ni, and Cr. However, there is no literature to our knowledge describing cutaneous LP due to contact or ingestion of high levels of copper due to a contaminated water supply. At this point, it is not known whether the patient developed this reaction secondary to cutaneous contact or systemic ingestion of the contaminant, but we postulate that it may have been the increased levels of copper that induced his condition.

Cold atmospheric plasma (CAP) has been clinically demonstrated to be an effective treatment for actinic keratosis (AK) in a number of case series. In this study, we evaluated the efficacy of CAP in the treatment of multiple AKs and assessed morphological changes induced on the skin field of cancerization both clinically and by high-frequency ultrasound (HFUS). Patients with multiple grade I–II AKs of the scalp and/or face who were resistant or intolerant to conventional field-directed treatments were enrolled. CAP treatments were performed using a microwave-driven argon plasma jet. At baseline and 3 months after the last CAP session, performance indexes were determined using three-dimensional digital pictures and HFUS investigations were performed on a representative Olsen grade II AK and a small spot of clinically unaffected skin within the test area. Twelve patients were enrolled in the study. All clinical variables showed a statistically significant reduction after CAP. HFUS evaluation revealed that the total, epidermal and dermal thicknesses of the target AKs had not changed with treatment. CAP therapy significantly increased dermal density in both the target AK and the surrounding photodamaged skin and signficantly decreased the thickness of the subepidermal low-echogenic band in the perilesional skin, which is an ultrasound sign of photodamage. Cold atmospheric plasma was found to be an effective treatment for patients with multiple AKs. CAP was not followed by skin atrophy. HFUS examiniation showed the CAP improved features of chronic photodamage of the dermis of the skin underlying and surrounding the AK spots.

Introduction: Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. Case report: We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. Conclusions: Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

The popularity of tattoos in the today's society brings with it a significant increase of the incidence of associated cutaneous reactions. Among the several complications that may occur after a tattooing procedure, allergic and photo-allergic reactions, infections, and Koebner phenomenon are the most common ones observed. Most of these complications may be avoided by identifying, before tattooing, the presence of risk factors or comorbidities that may increase the risk of their onset.

Background: Acne vulgaris is a multifactorial skin disease that may be triggered by the presence of the bacteria Cutibacterium acnes and is characterized by an increase in the sebum excretion. Cold atmospheric plasma (CAP) represents an innovative technological device that uses plasma, the fourth state of matter, to treat several skin conditions, considering its bactericidal potential and its efficacy in promoting tissue proliferation. Objectives: In the light of its well-known antibacterial properties and its promising regenerative properties, we assumed that CAP could be highly effective to treat acne vulgaris both in its acute phase and in the long-term cicatricial period. Methods: We reported the cases of two young patients affected by mild-moderate acne vulgaris of the face treated with CAP. In addition to the evaluation of inflammatory skin lesions, treatment efficacy was assessed by sebometry and trans epidermal water loss (TEWL) evaluation. Results: In both patients, acne lesions reduced after treatment. Both sebum excretion parameters and TEWL improved considering basal values. Conclusion: Despite the small number of patients enrolled, our data support CAP effectiveness in patients with mild to moderate acne vulgaris poorly responsive to other conventional treatments.